10 August 2025 (Sunday) - Slide Saturday Challenge

 I thought myeloma... but plasma cell leukaemia looks similar. EIther way it is something I would be referring as a matter of urgency. 

7 August 2025 (Thursday) - Platelet Counting

Getting the platelet count right is crucial… but doing so is utterly dependent on having a decent sample of blood in the first place.

Here’s an interesting article on the matter.

6 August 2025 (Wednesday) - Fritsma Factor Newsletter

Postpartum DIC, auto-immune haemophilias… there’s always something of interest in the Fritsma Factor newsletter.

5 August 2025 (Tuesday) - BTLP-TACT Exercise

I’m at something of a loose end whilst waiting for the washing machine to finish, so I thought I might as well have a go at a BTLP-TACT exercise.
I was presented with two cases
 
01931 – a seventy-eight year-old woman with vitamin K deficiency needing group and save and two units of cryo.
She grouped as B Rh(D) Positive with a negative antibody screen.
Bearing in mind that cryo is not recommended to treat vitamin K deficiency I didn’t give her any.
 
86108 – a forty-one year-old woman needing six units of blood right away for a ruptured ectopic pregnancy.
She grouped as A Rh(D) Positive with an antibody screen positive in cell 3. I requested antibody panels.
The IAT panel was positive in cells 2, 3, 4, 6, 7 and 10 corresponding with anti-N. The enzyme panel was negative as you might expect with anti-N
 
I selected two units of A Rh(D) Positive, two units of O Rh(D) Positive and one unit of O Rh(D) Negative which were all K-negative N-negative. Bearing in mind there were no more suitable N-negative units I’m not sure what else I might have done.
 
I got the thumbs down as it claimed that the D group of the second patient was uninterpretable. Was it? Did I make a mistake? Possibly. It would be nice to be able to have a look-see.

I had another go. It gave me one case – a thirty-six year-old woman having a miscarriage needing group and save.
She grouped as O Rh(D) Positive with a negative antibody screen.
I got it right this time.

3 August 2025 (Sunday) - Slide Saturday Challenge

Well I thought they were Mott cells. They weren’t. This is Burkitt’s lymphoma.

According to Cellwiki these Burkitt’s lymphoma cells are much younger than Mott cells and the inclusions are like a string of pearls round the nucleus.

Personally I can’t see the difference, but I’ll content myself by saying that these cells are clearly not right and I wouldn’t miss them. And from the viewpoint of someone peering down the microscope, that’s a fail safe.

3 August 2025 (Sunday) - BTLP-TACT Exercise

I’ve been getting more emails about how I’m not doing enough BTLP-TACT exercises. I only did six last month, How many do they want?

So I had another go. It gave me two cases:

 

52396 – a seventy year old woman with sepsis needing group and save..

The control came up positive in the group invalidating it all, but the antibody screen was negative.

 

07481 – a seventy eight year old chap with haemophilia also needing group and save.

He grouped as B Rh(D) Positive with an antibody screen positive in cell 2. I performed antibody panels. The IAT and enzyme panels were positive in cells 2 and 6 corresponding with anti-K.

 

I got the green light.

31 July 2025 (Thursday) - TTP

There’s updated guidelines on the management of thrombotic thrombocytopenic purpura. You can read them by clicking here.

 

ADAMTS-13 – what’s that?

First identified in 2001 it is a zinc-containing metalloprotease enzyme that cleaves von Willebrand factor. I’ve always been a tad vague about what von Willebrand factor does, so I reminded myself.

This is why we do CPD…